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US - Chicago: 2 O?Hare passengers quarantined for precautionary reasons after becoming ill on flights from Liberia

Re: US - Chicago: 2 O?Hare passengers quarantined for precautionary reasons after becoming ill on flights from Liberia

Link to PDF: http://www.uchospitals.edu/pdf/uch_041297.pdf

Statement from the Chicago Ebola Resource Network
Chicago ? Below is a joint statement from the following members of the Chicago Ebola
Resource Network: the Chicago Department of Public Health, Ann and Robert H. Lurie
Children?s Hospital, Rush University Medical Center and the University of Chicago Medical
Center.
The Chicago Department of Public Health, other city agencies and leading Chicago hospitals
have implemented protocols to respond in a coordinated manner in the unlikely event of an
Ebola diagnosis in Chicago. To be clear, at this time there have been no confirmed cases of
Ebola and there is no threat to the general public. Under the rigorous protocols put in place by
the City of Chicago and partners ? protocols that go above and beyond CDC guidelines ? two
travelers who arrived at O?Hare today are undergoing comprehensive medical evaluations at
Network hospitals following infectious disease protocols.
? A child passenger originating from Liberia became ill en route to O?Hare, reportedly
vomiting one time. Upon landing, the passenger was immediately screened by federal
authorities and found to have no fever, no symptoms other than reportedly vomiting one
time and no known risk of exposure. Following protocols implemented by the City of
Chicago, the passenger was transported to Lurie Children?s Hospital of Chicago, a
member of the Chicago Ebola Resource Network, for a full medical evaluation. Following
that evaluation, the CDC has determined not to test the patient for Ebola at this time.
Out of an abundance of caution and in consultation between the CDC, CDPH and
Network hospitals, the patient is being transported following stringent infection control
protocols to the University of Chicago Medical Center for ongoing observation in
isolation.
? The passenger?s family has also been screened and was found to have no symptoms
and no known risk of exposure. Per City protocols that go above and beyond CDC
requirements, the passenger?s family is under quarantine until the evaluation is
complete.
? Separately, an adult passenger traveling alone also originating from Liberia reported
nausea and diarrhea. The passenger reported having been diagnosed with typhoid fever
in August. Even though the passenger had a normal temperature and reported no known
risk of exposure during the screening, city protocols required the passenger undergo a
full medical evaluation at one of the Chicago Ebola Resource Network hospitals as a
result of reported symptoms. The passenger was transported to Rush University Medical
Center following stringent infection control protocols and is currently undergoing a
medical evaluation. Following that evaluation, it was determined not to test the patient
for Ebola at this time. City and hospital officials are working closely with the CDC to
continue monitoring.
? The two passengers are not related and were not traveling together.
? The Chicago Ebola Resource Network is a coalition of the Chicago Department of Public
Health and four leading Chicago-area hospitals formed as part of a coordinated
response to prepare for and respond to possible diagnoses of Ebola.
###
 
Re: US - Chicago: 2 O?Hare passengers quarantined for precautionary reasons after becoming ill on flights from Liberia

RE: "the CDC has determined not to test the patient for Ebola at this time.
Out of an abundance of caution and in consultation between the CDC, CDPH and Network hospitals, the patient is being transported following stringent infection control protocols to the University of Chicago Medical Center for ongoing observation"

Truly mind boggling! There is a massive contradiction between "an abundance of caution" and "has determined not to test the patient for Ebola". They think it's serious enough to transfer them to UCMC (which is far more costly than testing for Ebola!) but does not justify testing?!? :bat: :bat: :bat:

IMHO the real "problem" here is that if they tested, people would demand to know why they were not handling the patients as if they had Ebola at least until results were back and they are simply not prepared to do that, whether from lack of training, lack of equipment, unwillingness to pay the additional cost when it MIGHT not be needed (again the option chosen is always the least expensive one, no matter how inappropriate it may be). Let UCMC do the test and bear the expense of handling them as Ebola patients if they have it.

As Osterholm pointed out (he's apparently the only one aware of it), our past experience with Ebola covered only 5 generations at most, in any outbreak. And in the current outbreak the situation is so understaffed, under resourced and totally out of control and disorganized that the collection of data has not been remotely good enough to learn anything with any degree of certainty. We are not at all sure of how early in the disease patients become infectious.

Also note that the patient being diagnosed with typhoid fever in August is itself a significant risk of exposure to Ebola: presumably he'd have been treated. Throughout the area there would be many people with Ebola who went in to treatment centers and may have been diagnosed with a co existing condition, but not with Ebola (and thus their contacts not traced). A number of hospitals have determined patients to not have Ebola based NOT on a negative test for Ebola, but a positive test for something else with similar symptoms ("see! He doesn't have Ebola, it's just malaria" (because he tested positive for that).

The problem here appears to be the criteria used to "determine" not to test for Ebola at this time.

IMHO the only conceivable (and totally inappropriate) "reason" is that they do not want to know at this point whether it is or is not. On second thought make that "they want to NOT know". I suspect the reason is that they are not at all prepared to handle the situation if they do have Ebola and wanted a delay in order to be able to present at least an appearance of an operational plan at the time of any PR announcing that they do have Ebola.

While such a response might seem unthinkable in more civilized countries it is dead typical of how things are routinely handled in the USA, most especially in medicine. Medical tests are routinely "lost" (in the "circular file" (or more recently in the shredder)) when they come back with results that the physician is not prepared to deal with. Much of this has resulted from intense pressures to cut costs and the two tiered health "care" system. When such practices pervade a culture, they become the default way of dealing with a problem. What happens is that anything that involves any degree of interpretation gets an overwhelming bias if favor of the least costly option (which is why Duncan was sent home on the initial visit) and things that are objective with no room for misinterpretation get "lost".

If this seems horrendously dysfunctional it is. This is what a two tiered health care system results in. Epidemic diseases are totally blind and deaf to PR's, spin and outright distortions and totally unaffected by delusions. Ebola may be about to teach us a very hard lesson. If not Ebola, then H7N9 or HXNX or Nipah or the biggest risk of all: something which we are not yet even aware of.
 
Re: US - Chicago: 2 O?Hare passengers quarantined for precautionary reasons after becoming ill on flights from Liberia

So - I keep wondering - is the ebola test really expensive or what? Why would they not test them?
 
Re: US - Chicago: 2 O?Hare passengers quarantined for precautionary reasons after becoming ill on flights from Liberia

Plausible deniability.
The first person these 'health' agencies must contact is their risk management consultant.

A quick search for "risk management consultant ebola" brought these:

http://www.aon.com/ebola-response/

http://www.institutionalinvestor.co...-risk-of-economic-contagion.html#.VEfYkhbbB9k

http://usa.marsh.com/EbolaResponseCenter.aspx

Interesting peek into the mindset that might be driving the aversion to definitive testing for EVD.
 
Re: US - Chicago: 2 O?Hare passengers quarantined for precautionary reasons after becoming ill on flights from Liberia

There are also competing bureaucracies. I believe the CDC provides guidelines for who should be tested but the City of Chicago provides guidelines for who should be isolated.

Under the rigorous protocols put in place by
the City of Chicago and partners – protocols that go above and beyond CDC guidelines – two
travelers who arrived at O’Hare today are undergoing comprehensive medical evaluations at
Network hospitals following infectious disease protocols.
Click to expand...
 
Re: US - Chicago: 2 O?Hare passengers quarantined for precautionary reasons after becoming ill on flights from Liberia

http://www.ksl.com/?sid=32076838&nid=

CHICAGO (AP) ? Tests have determined that a child who had traveled from Liberia to Chicago does not have Ebola.
[...]
The adult as removed from isolation at Rush University Medical Center after doctors determined the patient's mild symptoms were attributable to previously diagnosed typhoid fever.
 
Re: US - Chicago: 2 O?Hare passengers quarantined for precautionary reasons after becoming ill on flights from Liberia

nola_mnr said:
There are also competing bureaucracies. I believe the CDC provides guidelines for who should be tested but the City of Chicago provides guidelines for who should be isolated.
Click to expand...

This is just sinking in...
So if 'sparks' keep landing here from Africa, and each agency with a stake in public health can have their own set of rules for dealing with possible ebola cases, there are too many ways this could get out of hand.
 
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